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Background COVID-19 (C-19) infection can acutely cause organ dysfunctions, especially cardiorespiratory, even with a long recovery period, inducing a significant functional deficit. Aim of the study was to evaluate the impact of a holistic hospital intensive rehabilitation program, based on CR, on C-19 patients (P), after acute care, to improve their fitness, in order to return to their life in the best conditions. Methods In the period april-august 2020, 30 P (mean age 73 years, 60% male) were admitted to the rehabilitation centre at a mean distance of 31±11 days from the onset of C-19; 34% of them had undergone prolonged invasive ventilation, 34% non invasive ventilation and 32% required high flow oxygen. Comorbidities were: hypertension (77%), diabetes (13%) and chronic coronary syndrome (10%); 18 P were unable to stand, and 12 showed impaired trunk control. No P had impaired LVEF or significant valvular disease. Initially, the program focused on training for trunk and sitting control; then on exercises for straightening the upper and lower limbs. From the second week, started a CR training on the cycle ergometer 10–20 minutes a day for 6 days a week, similar protocol to that used in P with heart failure. The aerobic training was of moderate intensity, not exceeding 40–60% of the maximum heart rate, Borg scale 10–12, starting with zero load, gradually increasing by 10–15 watts and up to a minimum target of 25–30 watts. The impact of the protocol on motor functions [MRC Muscle Strenght Scale, Short Physical Performance Battery (SPPB)] on functional capacity [6 Minutes Walking Test (6MWT)] on anxiety (A) and depression (D) [Hamilton Anxiety Rating scale (HAMA) and Hamilton Depression Rating scale (HAMD)] and on basic activities of daily life [Barthel Index (BI)] were evaluated. The assessment was done on the admission (T0), at the discharge (T1, on average after 31 days) and after a follow-up of 55 days (T3). Results The results are shown in the table below. Only 4 P were able to perform the 6MWT at T0. The motor function improves rapidly and then reaches a plateau and its trend is reflected in the BI. Functional capacity, on the other hand, improves significantly even at a distance. A and D decreased rapidly but increased over time. Conclusions A rehabilitation protocol, centered on CR, induces a rapid increase in motor capacity, even in severely compromised subjects such as C-19. The improvement in fitness over time, as demonstrated by the 6MWT, probably is due to the severe muscle deconditioning, for the long stay in acute care. The long-term worsening of A and D may depend on various causes: no longer living in a “protected and safe” place, the fear of relapse, returning home and discovering new deaths and mournings. A program, CR-like, can counteract many of the negative consequences of C-19; however these P deserve an outpatient rehabilitation to maintain and consolidate the positive results over time. Funding Acknowledgement Type of funding sources: None. Table 1

The Brazilian Nuclear Energy Commission (cnen) has been making a constant effort to keep up to date with international standards and national needs to strengthen the status of radiological protection of the country. The guidelines related to radiation therapy facilities have been revised in the last five years in order to take into consideration the most relevant aspects of the growing technology as well as to mitigate the accidents or incidents observed in practice. Hence, clinical dosimeters have gained special importance in this matter. In the present work, we discuss the effectiveness of regulation and inspections to the enforcement of instrument calibration accuracy for the improvement of patient dosimetry and quality control. As a result, we observed that the number of calibrated instruments, mainly well chambers, is increasing each year. The same behavior is observed for instruments employed in technologically advanced radiation treatments such as intensity modulated radiotherapy, volumetric therapy and stereotatic radiosurgery. We ascribe this behavior to the new regulation.

Anthropogenic activities have caused profound changes globally in biodiversity, species interactions and ecosystem functions and services. In terrestrial systems, restoration has emerged as a useful approach to mitigate these changes, and is increasingly recognised as a tool to fortify ecosystems against future disturbances. In marine systems, restoration is also gaining traction as a management tool, but it is still comparatively scant and underdeveloped relative to terrestrial environments. Key coastal habitats, such as seaweed forests and seagrass meadows are showing widespread patterns of decline around the world. As these important ecosystems increasingly become the target of emerging marine restoration campaigns, it is important not only to address current environmental degradation issues, but also to focus on the future. Given the rate at which marine and other environments are changing, and given predicted increases in the frequency and magnitude of multiple stressors, we argue for an urgent need for subtidal marine macrophyte restoration efforts that explicitly incorporate future-proofing in their goals. Here we highlight emerging scientific techniques that can help achieve this, and discuss changes to managerial, political and public frameworks that are needed to support scientific innovation and restoration applications at scale.

A prospective, randomised study was conducted to evaluate the clinical and functional outcomes at 12 months of followup in two groups of patients affected by femoral neck fractures and treated with cemented or cementless bipolar hemiarthroplasty. Fifty-three cemented and 53 cementless prostheses were implanted on alternate days in 106 consecutive patients. We considered general demographic variables (age, sex, side of injury), operative delay, number of pre-existing conditions, ASA score, haemoglobin levels at admission and pre- and postoperatively, number of blood units transfused perioperatively, duration of operation, clinical complications, hospital stay and mortality within one year after discharge. At follow-up, a Total Functional Score (from 0 to 18 points) was used to evaluate walking ability and personal and daily activity. Furthermore, the economic costs of hospital care (medical and nursing staff, drugs, diagnostic procedures, blood transfusions, hospital stay) and prostheses in the 2 groups of patients were considered. There was no significant difference between the 2 groups of patients regarding most variables, except for postoperative haemoglobin value (9.60±1.88 g/dl in cemented group vs 8.80±8.70 g/dl in cementless group, p=0.018) and duration of operation (75.00±22.43 min in cemented group and 56.98±55.00 min in cementless group, p

An increasing incidence of rectal injuries following patient self-induced harmful acts, aimed to sexual or laxatives porpouses, is a fact reported in literature (El-Ashaal et al., 2008). We herein report a case of severe hemoperitoneum related to a middle and upper rectal third seromuscolar tear caused by a self-induced fecal evacuation by means of an arrow with a covered cork tip. An urgent intestinal diversion by means of a Hartmann's operation was performed. The clinical case is presented in relation to the literature debate, regarding the issue of primary repair or resection and anastomosis versus fecal diversion for penetrating rectal injuries (Fabian, 2002; Cleary et al., 2006; Office of the Surgeon General, 1943; Busic et al., 2002). In conclusion, the importance of avoiding an anastomotic breakdown in a patient undergoing a hemorrhagic shock is highlighted.

Summary We report our experience in seven patients with congenital gigantism of the foot with the following diagnoses: neurofibromatosis (two), fibrolipomatosis(two), Proteus syndrome (two), and idiopathic localized gigantism (one). Our purpose is to introduce a new classification of foot gigantism, based on the concept of “neuroinduction.” In our experience, intraoperative examination and subsequent histologic examination show consistently pathologic findings in the plantar nerve and its terminal branches in the foot affected by gigantism. Limited surgical treatment was used in five patients. To prevent forefoot enlargement and recurrence of deformity, we suggest complete ray resection. We evaluated our results using radiographs, functional status, and cosmetic considerations.

Summary From 1980 to 1996, 1,907 consecutive euthyroid subjects with palpable thyroid nodules were examined by fine needle aspiration (FNA) cytology plus large needle aspiration biopsy (LNAB) histology. There were 1,630 (85%) women and 277 (14.5%) men aged from 17 to 80 years. A single nodule was palpated in 1,419 subjects (74.4%) while 488 (25.6%) showed multiple nodules. The nodule size ranged between 1 and 7.5 cm. The number of inadequate specimens at the first examination, FNA cytology or LNAB histology, were 261 (13%) or 398 (20.8%), respectively. LNAB performed on the 261 nodules with nondiagnostic cytology showed findings which were adequate for diagnosis in 130 (49.8%) and inadequate in 131 (50.2%). Among the 261 patients with inadequate initial cytological findings 61 were subjected to repeated FNA and 36 repeated LNAB. More than 60% of the nodules on which FNA was repeated achieved a cytological diagnosis; more than 80% of the nodules reinvestigated by LNAB were finally diagnosed by histology. The mean nodule size was larger in the group with inadequate result than in that with adequate FNA or LNAB result. Among the 261 patients with inadequate cytological finding at the first FNA 28 were operated on; 20 were in the group with adequate LNAB histological findings and eight in the group with an inadequate LNAB. Two papillary cancers, one per group, were found at postoperative histology. However, one was diagnosed by LNAB and one at the second FNA. The remaining 26 nodules were all found to be benign postoperatively. This study shows that the addition of LNAB to FNA leads to a histological diagnosis in 50% of the palpable thyroid nodules with inadequate cytology at the first FNA and that LNAB can be used even for those nodules which remain uncharacterized after repeat FNA

Innovation in wireless communication enables the majority of the worlds population to use mobile phones and wireless networks. Ubiquitous communication requires sophisticated networks, well- connected mobile devices, progress in base-technologies and communication paradigms. The LOEWE priority program Cocoon (Cooperative Sensorcommunication, funded by the state of Hesse, Germany) puts an emphasis on comprehensive research in the field of networks, signal processing and reconfigurable transceiver architectures, and aims to verify the usability of these communication paradigms in Smart Cities and Car-to-X communication.

Ray tracing (RT) techniques are widely employed to estimate the field levels both in urban areas and within building (indoor propagation). The radio propagation is modeled as a set of plane waves, approximated by rays which, undergoing multiple scattering phenomena (reflection, diffraction, transmission), link the transmitting to receiving antennas. Typically, the computational time of RT tools quickly increases as the complexity of the scenario and the maximum order of bouncing allowed grow. Several acceleration techniques have been proposed based on a reduction of the total number of ray-facet intersection tests [1-2-3]. In order to reduce the allowed rays, one can resort to algorithms typically employed in computer graphics: to this end, an evaluation of visibility relations between pair of facets and between facets and transmitting/receiving antennas is needed (two objects - antenna or facets - are visible if and only if a not occluded direct ray can be traced between them).

The purpose of video summarization, when used in an interface, is to extract from a video a limited number of key-frame that convey the meaning of the whole video at a glance. The development of cut detection and key-frame selection algorithm is based on the unspoken assumption that such meaning is conveyed not only by the sheer number of frames that is being presented, but that the comprehension of the video is increased by a careful choice of these frames. This paper presents an experiment that challenges this assumption. Two videos were synthetized using careful frame selection and using a uniform sampling of the video with the same number of frames, and the comprehension of two group of subjects was tested by asking them questions about the videos. The experiment revealed no difference between the comprehension gained by seeing the carefully selected key-frames and that gained by looking at the uniform sampling of the video.

Background: The aim of this study was to evaluate 17 patients undergoing laparoscopic adrenalectomy for the treatment of pheochromocytoma by transperitoneal anterior approach. Methods: Seventeen patients underwent laparoscopic adrenalectomy for pheochromocytoma between January 1994 and May 2002. Ten females (58.8%) and 7 males (41.2%) were operated on; 14 patients (82.3%) had sporadic pheochromocytoma and 3 (17.7%) were familiar cases. Mean age was 42 yr (range 25–72 yr). All patients were treated pre-operatively with α-blockers. Seven patients (41.2%) underwent right adrenalectomy; 9 (52.9%) underwent left adrenalectomy and 1 (5.9%) bilateral adrenalectomy. Results: No conversion to open surgery occurred and no mortality was observed. The right-side adrenalectomy required a mean operative time of 86 min (range 45–120), the left-side procedure a mean operative time of 116 min (range 80–140) and the bilateral one 219 min. In two patients (11.8%), a laparoscopic cholecystectomy and ovariectomy, respectively, were performed without changing the position of the patient on the operating table. Only 1 patient (5.9%) presented significant intraoperative hypertension, and arrhythmia resolved by medical therapy. No other intraoperative and post-operative complications were reported. Mean hospital stay was 3 days (range 2–8 days). At mean follow-up of 48 months (range 6–96 months), regression of symptoms and control of blood pressure were obtained without additional treatment in all patients. No recurrences were reported. Conclusion: In our experience, adrenal pheochromocytoma can be treated safely and effectively by laparoscopic transperitoneal anterior approach.

The development of real time control systems not only requires the design of control strategy, but also the search for tradeoffs between control specifications, supervision logics, tasks scheduling and plant dynamics or constraints. This is particularly true for automotive applications where mechanics and electronics are strongly tightened together. In this paper we present a modeling approach for the integrated simulations of both vehicle dynamics and functional behavior of the control systems. By exploiting Modelica features, it is ongoing the development of a library of reusable models that will allow to build and mimic the dynamic behavior of vehicles in any propulsive configuration with particular attention to the hybrid ones. Besides the physical components models a multi tasking electronic control unit (ECU) object oriented model, based on IEC 1131 standard, is also proposed to analyze pseudo parallel computing effect on control efficiency.

A phase II study was performed to evaluate the clinical and immunological effects of a regimen of cisplatin (DDP) and etoposide (VP-16) combined with thymosin-alpha 1 (TA1) and low-dose interferon-alpha 2a (IFN) in the treatment of patients with advanced non-small cell lung cancer (NSCLC). Chemoimmunotherapy cycles were repeated every 3 weeks. There were 24 responses (two complete, 22 partial) among 56 assessable patients. Median survival was 12.6 months. Overall, treatment was well tolerated. Natural killer cell activity and lymphocyte subtypes were depressed by chemotherapy, but this effect was less prominent in patients receiving TA1 and IFN in comparison with a concomitant group of patients treated with DDP and VP-16 only. The combination of DDP and VP-16 and TA1 and IFN is effective in advanced NSCLC with acceptable toxicity. However, the results of this study need to be confirmed in a randomised trial.

Background The term ‘common mole’, often used to describe a subset of benign pigmented skin lesions, is traditionally defined on the basis of morpho-chromatic features. In recent years, certain research groups have developed equipment and methods, such as digital dermoscopy analysis, that enable objective evaluation of pigmented skin lesions. Objective In this study we use a digital dermoscopy analyser trained for the recognition of pigmented skin lesions to compare the subjective definition of ‘common’ and the mathematical concept of ‘close to the mean of measurements’. Methods A subset (100) of digital images of flat pigmented lesions, obtained in daily practice, were classified by trained and non-expert clinicians as common moles (60) or clear-cut melanoma (40), and processed with a DB-Mips analyser. The resulting parameters, validated by a classifier, were used to evaluate Hotelling's T2 multivariate distances from the mean. Results Common’ moles could not be clearly defined in terms of closeness to the means of objectively evaluated parameters. Their diagnosis includes many other evaluations and clusters of variables. Conclusion The clinical semantics of the term ‘common’ does not conform to any unambiguous mathematical definition.

We compare several possible approaches to the measurement of similarity and differences in visual information management systems. For many visual information retrieval applications, it is important to order the data according to a scale as close as possible to the human judgement. Traditional techniques based on the measurement of Euclidean distance between points in feature space prove often unsatisfactory. Data about the measurement of similarity can be derived from the psychological literature. F. Attneave (1950) performed a series of experiments to measure how the perception of similarity changed when a number of features of the stimulus were changed continuously. His findings definitely rejected the hypothesis that the human perceptual system may compute a Euclidean distance between the two stimuli it compares. He found a strong nonlinearity that suggested that the same variation in the features was weighted more when the two stimuli were very similar than when the two stimuli were wide apart. Also, he supported experimentally an hypothesis due to Householder that distances along independent perceptual axes were summed, as in the "city block" distance. >

In this paper we investigate about the possibility of an idle-speed control law, simple enough for real-time applications. Our design approach takes explicitly into account the presence of finite time delays between manifold pressure and spark advance inputs and the resulting torque output. Effectiveness and robustness of the control scheme are shown through computer simulations.

Artificial intelligence once sought to make computers complex enough to become sophisticated participants in human culture. These same techniques now simplify humans enough to integrate them into computer culture.

In this paper we present a novel approach to the problem of three-way catalytic converter dynamic modeling; one of the main issues related to modeling these devices is the reaction kinetics submodel, that has to be at the same time simple and flexible enough to capture all the significant features of the real system. We propose the use of machine learning techniques to solve this problem: a neural network structure for the kinetic submodel and a genetic algorithm to tune its parameters. In this way the difficulties arising from the identification of the resulting overall model are avoided.

The improvement in computational power has allowed researchers to model and simulate dynamical systems of growing complexity. In particular, we report on the construction of a reference model to be used as a workbench to design and test control strategies aimed at minimizing the global emission of three-way catalytic converters (TWC) in non-steady-state conditions. This problem is of great interest to industrial application since vehicle emission standards are becoming stricter, and a detailed mathematical description of TWC is thus necessary for the optimization of its performance. In this perspective, we also present a reduced order model for the purpose of real-time implementation.

Background: A phase II study was performed to evaluate the clinical and immunological effects of a regimen of fluorouracil (5-FU) and folinic acid (FA) combined with thymopentin (TP-5) and interleukin-2 (IL-2) in the treatment of patients with metastatic colorectal cancer. Patients and methods: Forty-five evaluable patients with measurable colorectal cancer and no prior therapy for metastatic disease were treated with 5-FU 400 mg/m(2)/d and FA 200 mg/m(2)/d i.v. on days 1-5, TP-5 50 mg s.c. on days 8-11, and IL-2 9 MLT/m(2) s.c. twice daily on days 12-16. Cycles were repeated at 4-week intervals if toxicity had resolved. Immunological changes were evaluated in 13 patients and compared with a well matched series of 13 patients treated with the same regimen without TP-5. Results: Two complete responses and 17 partial responses were seen (42%; 95% confidence interval, 28% to 56%). Fifteen patients (33%) had stable disease. The median time to progression was 8.5 months and the median survival 13 months. Treatment was reasonably well tolerated, and there was no overlapping toxicity or interference between chemotherapy and biotherapy. Hematological and immunological changes during treatment were qualitatively similar to those expected with IL-2+/-chemotherapy. Quantitatively, significant changes (higher levels of IL-2, CD25 and IFN-gamma, and lower levels of sIL-2R) were observed in patients given TP-5. Conclusion. The combination of 5-FU + FA and TP-5 + IL-2 is effective in advanced colorectal cancer with accept able toxicity. Immunological data suggest that TP-5 may modulate the action of IL-2 in the clinical setting. However, improved treatment approaches are needed, and the interactions between thymic hormones and cytokines should be further explored.

210 children aged less than 5 years, referred to the Arua Regional TB Centre (Uganda) for suspected pulmonary tuberculosis (PTB), were examined by anamnesis, clinical examination, Mantoux test, gastric washing, chest X-ray. The response to treatment criterion was applied to the patients treated. According to the score method suggested by Ghidey and Habte, 31 children were diagnosed as PTB patients. 30 of the 31 children with PTB tested positive for alcohol acid-fast bacilli (AAFB) in the aspirated juice. The Mantoux test and X-rays gave a minor contribution to diagnosis. The clinical results are commented. A statistical analysis was carried out to evaluate the role of gastric washing in the diagnosis of PTB in children under 5 years of age (sensitivity, 96.8%; specificity, 92.2%; positive predictive value, 68.2%; negative predictive value, 99.4%). The response to treatment was also evaluated. A modified enlarged score method (based on gastric washing and including response to treatment) is proposed to be applied in developing countries where chest X-ray and other facilities are often lacking.

A 41 year old female presented with non-specific abdominal pain and intermittent hyperpyrexia (38°C); she had been recently treated for apical granulomas with an otherwise negative medical history and clinical examination, including a normal body mass index. At presentation the patient had not …

The evidence of a dose-response effect to anthracyclines in advanced STS prompted us to begin a clinical trial with HD-EPI. We have already reported (Proc ASCO II:414, 1992) a 14% response rate with EPI 120 mg/m2 iv q 3 weeks in 36 sarcoma pts. Since April 1991,48 pts were treated with EPI 160 mg/m2 iv q 3 weeks. Clinical characteristics of pts are the following: M/F = 26/22, median age = 52 years (14–72), median (WHO) PS = 1 (0–2). Pre-treatment: surgery 34/48, chemotherapy 1/48, radiotherapy 15/48, stage of disease IIIB = 17%, IV = 83%. Median number of cycles (in 43 pts evaluable for response) = 6 (range 2–8), median cumulative EPI dose = 740 mg/m2 (range 290–1280 mg/m2). We observed 3 CR and 13 PR (37%) [95% CI, 23%-51%] 14 NC (33%); 13 PD (30%). Responses were observed in 6/IIIiposarcoma, 2/6 leiomyosarcoma, 1/5 MFH, 2(8 synovial sarcoma, 1/3 malignant schwannoma, 1/3 fibrosarcoma, 1/2 stromal sarcoma, 2/4 other types. Median duration of response was 10 months (range 4–38+). Median time to progression was 9 months (range 3–42+). Median overall survival was 14 months (range 3–42+) with a significant difference between responding (17 months) and progressive pts (6.5 months). The most important side effect was myelotoxicity with leukopenia occurring in all patients (G4 38%), thrombocytopenia in 36% (G1–G2 18%) and anemia in 72% (G1–G2 53%) of the pts. In 11/43 pts (26%) EPI dose was reduced because of myelotoxicity. Neutropenic fever occurred in 28% of the pts. Stomatitis was recorded in 36% of the pts and N/V (G3) in 6% of the pts. Cardiotoxicity was monitored in 24 pts by radionuclide angiography. Only 3/24 pts experienced a ≥20% decrease in left ventricular ejection fraction at cumulative doses of 880 mg/m2, 960 mg/m2 and 1280 mg/m2, Clinical cardiotoxicity was not observed. HD–EPI is an effective and reasonably well tolerated treatment in advanced STS. In comparison to our previous study a dose–response effect has been observed at EPI doses of 160 mg/m3. The accrual of pts continues to better define the effectiveness and the toxicity of this treatment.

Highlights • Hormonal receptors positive breast tumor and prostate cancer are managed with endocrine therapies. • Endocrine therapies designed for breast and prostate cancer are often associated to serious adverse skeletal related events, such fractures. • Denosumab is a monoclonal anti-body binding RANKL which acts as inhibitor of osteoclasts activity, thus increasing bone mass. • Denosumab was showed to strongly prevent hormonal therapies-related skeletal issues. • Denosumab administration results safe in bone mass increase and reduction of fractures risk., Hormonal therapies for receptor positive-breast and prostate cancer patients have shown clinical efficacy but also several side effects including osteoporosis, loss of bone mass and increased fracture risk. Denosumab represents an anti RANKL (receptor activator of nuclear factor-kB ligand) monoclonal anti-body acting as inhibitor of osteoclasts formation, function, and survival, then increasing bone mass. Herein, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the role of Denosumab in saving bone health in prostate and breast cancer patients receiving respectively androgen deprivation therapy and adjuvant endocrine therapy. Moreover, selected patients have to be treated with Denosumab at the dose of 60 mg every six month or placebo. Outcomes studied included the bone mass density (BMD) increase at 24 and 36 months, BMD loss, reduction of fractures risk (in particular vertebral) at 24 and 36 months and safety (overall, serious adverse events – SAEs and discontinuation rate). Our results showed a reduction of the BMD loss up to 36 months both at the lumbar and femoral level and a BMD increase both at 24 and 36 months. It was also found a reduction in the number of new vertebral and femoral fractures at 24 and 36 months. Finally, our pooled analysis showed that Denosumab did not affect both the SAEs and therapy discontinuation risk. In conclusion, Denosumab administration can be considered effective and safe in the prevention and management of the above mentioned adverse events related to hormonal therapies designed for breast and prostate tumors.